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Crazy hypo in the morning

Hill28

Well-Known Member
Messages
179
Type of diabetes
Type 1
Treatment type
Diet only
Dislikes
Uhm..diabetes
This morning i had a really terrible experience.

i woke up around 6:00 and checked my bg: it was 12,2 mmol.

i decided to take my lantus log term insulin shot of 25 units.

i snoozed my alarm to wake up at 6:58 to wake up with a bg value of 2,2 and a further downward trend. 1 minute later my Libre indicated LOW. I immediately drank 1 liter of fruit juice (69g of carbs). 7:17 still low value and feeling dizzy.

so called an ambulance in case i wouldnt be able to stop the hypo, and then went to the local 24h store to buy 3 bottles of AA drink (14,5g carbs/100ml).

ambulance arrived to monitor me and i drank 2 bottles aa drink. Bg went back above 4,0 at 7:45 without further medical intervention.

i’m not sure if i could have accidentely switched the lantus insulin for novorapid. Or if the lantus can do such crazy stuff. I never had such heavy drops within just one hour. However, Not a nice experience at all.
 
Hope your feeling better , to be honest I read about half of your post and instinctively I thought he’s taken his short acting by mistake, it would certainly give you the same situation if you had, don’t know if you do but different coloured injection pens can help prevent this . Glad all is back to normal
 
Hi,

I thought the same as @Ushthetaff ,

Could you have injected your Lantus into muscle?
 
No not into muscle probably as i never inkect into my legs.
I could have switched the lantus and novorapid as it was early and still dark. But both insulinpens ‘feel’ very different (flexpens) so normally i wouldnt switch them. The ambulance crew told me to keep the novorapid in the kitchen instead of taking it with me to my bedroom from now on.
 
Antje77 said:
Lantus can do this when some of it hits a capillary.
It gave me the scariest hypo I've ever had and I switched to a different long acting after this happened.
https://www.diabettech.com/diabetes/lantus-lethal-or-lifesaver-doc-gbdoc/
Click to expand...

This one was really scary too as it took so long and wasnt sure if i switched the insulin and if i could drink enough sugar to overcome 25 units of novorapid, in case i took the wrong insulin.

its not nice to hear Lantus caused this in your situation. May i ask to what insulin you have switched now?
 
Hill28 said:
its not nice to hear Lantus caused this in your situation. May i ask to what insulin you have switched now?
Click to expand...
Sure!
I've been on Tresiba for quite a while now, apart from getting rid of this possible side effect of Lantus, I like it a lot better because I find it much more stable for me, no stinging, and no exact timing too (I take it anywhere between 10PM and 4AM, depending on bed time without noticing a difference).

Should my HCP have been unwilling to prescribe Tresiba, I would've been happy with Levemir as well, despite the twice a day injecting, but she was happy to get me on Tresiba
 
I keep my short acting and long acting in separate rooms for this same reason! I use cartridges, so I have the novo pens that have the timers on the end so that you can see how many units you gave and roughly how long ago. I think you can buy the attachment for flexipens online? at least then if you ever think you gave the wrong injection, you can check and hopefully catch a hypo before it gets too low.
 
I too have had one (possibly two depending on whether I mixed up my pens the first time) lantus lows, my endo won't prescribe tresiba or levemir (I'm in NZ which is relatively limited in the insulins it supplies) so I'm coping by swapping to 4mm from 8mm needles, being more careful where I inject and always waiting 15 minutes before I go to sleep to make sure my night time lantus isn't making me plummet.

I also have a pot of 50 glucotabs (so approx 200g in carb) next to my bed, so if I start plummeting I can crunch 10 of these which should stop the plummet even if it's a lantus low. (1 or 2 takes me out of a normal hypo).

Study: Glucose Tablets Should Be First Treatment Choice for Hypoglycemia – Diabetes Daily

Googling suggests that having a back up supply of glucose tablets may be better than fruit juice (and honestly the thought of leaving the house while hypo to source more sugar strikes me as pretty dangerous, better to have a secret stash of glucose tablets.

Just a thought, but if it wasn't a lantus low you should find that there is no basal at all left in your system once your morning mistake wears off, whereas if it was a lantus low some of it may still act throughout the day. Of course, there'll be less lantus than normal in your system, so it may not be obvious.

Good luck. Steep hypos are very scary.
 
Hill28 said:
This one was really scary too as it took so long and wasnt sure if i switched the insulin and if i could drink enough sugar to overcome 25 units of novorapid, in case i took the wrong insulin. ...
Click to expand...
The liver holds enough glucose to deal with most hypos, so you would probably have been ok even if you had slept through it. Having said that, 25 units is a lot of insulin to inject all at once. That doctors are comfortable with this practice puzzles me. Splitting the dose over two shots, morning and evening, is a lot safer. It also reduces variability by up to half, making steady control a lot easier.
 
25 units of long acting is a completely normal dose, and taking your long acting in one go on Lantus/Basaglar/Toujeo/Tresiba is perfectly common practice too.

As for the liver 'dealing with most hypo's', please don't discard the many diabetics who have needed an ambulance or glucagon to get them out of unconscious hypos with convulsions.
Hypo's can be very dangerous.
 
Thanks for all of your replies
Looks like it could have been a ‘lantus low’ as well, but will probably never know.
I tried Levemir before Antje, but it gave me blue spots. Maybe tresiba which you mention is different, i will check it out. Also the timer that can be added to the pen!

Btw I can def confirm that the liver can not always get you out of a hypo.
 
Your hypo must have been horrible. I am glad you are feeling better.
I am concerned you had to go to a shop during a hypo for fast acting carbs. I realise this morning’s experience is unusual but please make sure you have plenty of fast acting carbs in your house and top up those that were used today. Don’t wait until your next hypo.
 

Hi Mark,

I used to play "ride the hypo in" my youth. Don't try this at home. Pushed the limits.
These days it's a little more "scientific" with a CGM setup?
I've estimated that my personal liver dump (fight or flight response) can have a simalar effect to ingesting 10g?
& that's just waking with a great FBG then fot on the floor during the scrabble for work.
However. Once that arrow is heading south, with a hypo who knows where it may possibly take you?
First response is treating it. Relying on a liver dump especially where alcohol may have been consumed the night before? Is not the best idea.
 
Jaylee said:
First response is treating it. Relying on a liver dump especially where alcohol may have been consumed the night before? Is not the best idea.
Click to expand...

Yes, I've had a couple of night time hypos where my husband thought I was dead and/or dying (oh the joys of pre cgm pregnancies) and honestly wouldn't be confident that my liver would have pulled me out in time.... And my last lantus low took half a day's worth of carbs to bring me up from that vertical down arrow....

But having said that, 50 years of T1 and plenty of alcohol, and I'm still alive, so I suspect my liver has helped me.. My pancreas might not be producing insulin, but I'm really grateful for its glucagon. (Going off topic, anyone got a good way to remember which is which of glycogen and glucagon, I always have to check I haven't got the names the wrong way round?)
 
MarkMunday said:
Isn't it odd that we are encouraged to use a practice that increases the risk?
Click to expand...
I’ve was injecting single Lantus doses for years and never considered it a risk. I have never mixed my pens.
I think fear of mixing them is far greater than the risk of actually doing it.
And, for me, the inflexibility of having to inject 12 hours apart just to split the dose because ... would be much worse. I would forget or have to carry my Lantus with me at all times rather than keeping my pens separate to avoid mixing them up.

As has been said many times, we are all different. We manage our diabetes, our lives and our fear of risk differently.
If you are happier to split your dose, continue to do so but as insulins are developed that last longer (such as Tresiba), I would not be surprised if fewer rather than more people split their basal.
 
MarkMunday said:
Isn't it odd that we are encouraged to use a practice that increases the risk?
Click to expand...
No, it isn't. It's only the insulin glargine (Lantus, (a)basaglar, and Toujeo) holding a risk of bizarre hypo's, not any of the other long acting insulins.

I take 84 units of Tresiba at the moment. You say that to your thinking 25 units should be split into 2 for safety. Should I conclude you think I should split my basal insulin over 6 injections? What about people using 200 units of basal? Should they inject 16 times for basal only because you, and not their endocrinologist, think 25 units at once is too much?

Please consider the differences between different people and remember what works for you may not be the best solution for everyone else.

The only time I have ever had a serious hypo was that one time on Lantus. For the last 3 years my bg's have been managed very well without splitting my dose of long acting, and while I'm very much afraid of Lantus, I found my current long acting insulin to be very stable and predictable, I don't feel it as a risk at all to inject it only once a day.
 
MarkMunday said:
Isn't it odd that we are encouraged to use a practice that increases the risk?
Click to expand...

Mark, the topic does not involve the malpractice of healthcare professionals.
 
Antje77 said:
... Please consider the differences between different people and remember what works for you may not be the best solution for everyone else. ...
Click to expand...
My response was to the OP, someone taking 25 units of basal a day. So clearly insulin sensitive. There was also clear anxiety about hypos, which is not uncommon. Hypos can happen for various reasons, and reducing the size of insulin shots always reduces this risk. Regardless of total daily dose. It almost goes without saying.

I live alone, so I simply can't have a hypo I am not able to treat. I reduce hypo risk by minimising the size of insulin shots. It works very well. That this has never been suggested to me by a caring and perceptive medical professional over the last 43 years is disappointing to say the least. It is also why I point this approach out to people also grappling with the issue.
 
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